Period Covered:: Report of Checks Issued
Period Covered:: Report of Checks Issued
Period Covered:: Report of Checks Issued
Entity Name :
Check
Responsibility Center UACS Object
DV/Payroll No. ORS/BURS No. Payee Nature of Payment Amount
Date Serial No. Code Code
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CERTIFICATION
I hereby certify on my official oath that this Report of Checks Issued in ONE (1) sheet(s) is a full, true and correct
statement of all checks issued by me during the period stated above for which Check No. inlusive,
were actually issued by School Tresurer in payment for obligations shown in the attached disbursement vouchers/payroll.
Prepared By:
Administrative Assistant III